THE GLUTEN-FREE
NUTRITION GUIDE
OPTIMIZING THE GLUTEN-FREE DIET
By Cynthia Kupper / Executive Director
Factors affecting nutrition
• Economic status
• Disabilities
• Immediate social situation
– Living alone/isolation
– Number living in home
• Urban/rural living
• Depression
• Dependency
• Mental health
• Oral health
• Diet related diseases or
conditions
• Multiple medication
needs
• Minority status
• Age
Potential problems for persons
following a GF Diet:
•
•
•
•
•
•
•
•
•
•
 Fiber, carbohydrate
 Fat intake
 Iron
 Folate
 Niacin
 Vitamin B-12
 Calcium
 Phosphorus
 Zinc
 Vitamin D
•  Quality of Life
– Cost of GF living
– Availability of foods
– Social inconveniences
– Continued GI symptoms
– Possible weight changes –
gain vs. loss
Nutritional Adequacy of Gluten-Free Diet
Nutritional
deficiencies of a
Gluten-Free Diet
Improvement after
starting Gluten
Free Diet
Serum Hemoglobin
x
Iron
x
Zinc
X*
Inadequate intake
after starting
gluten free diet
Fat
x
Carbohydrate
x
Fiber
x
Niacin
x
B12
x
Calcium
x
Phosphorus
x
Zinc
X*
American Dietetic Association, Evidence Based Library,
http://www.adaevidencelibrary.com/template.cfm?template=guide_summary&key
=2102, accessed on 3/23/2011
* Zinc levels has been
shown to improve after
starting a Gluten-Free
Diet (GFD) as a result of
intestinal healing and
improved absorption, but
the average daily intake
in a GFD is inadequate
to meet RDA for zinc.
Nutritional Adequacy of GFD
• If a gluten-free diet does not provide an adequate supply of the
nutrients at risk (iron, folate, niacin, vitamin B12, calcium, phosphorus
and zinc), it many be wise for people with celiac disease to consume
a daily gluten-free age- and sex-specific multivitamin and mineral
supplement.
• Whole grain carbohydrates in the form of brown rice, wild rice,
buckwheat, quinoa, amaranth, millet, sorghum, teff can add healthy
carbohydrates as well as fiber to a GFD.
American Dietetic Association, Evidence Based Library,
http://www.adaevidencelibrary.com/template.cfm?template=guide_summary&key=2102, accessed on
3/23/2011
Potentially problematic nutrients for
mature adults:
•  Protein intake - leads to
– muscle wasting
– weakened immune status
– delayed wound healing
• High saturated fats and transfats intake – leads to
–  risk for chronic heart
disease
•  Vitamin D
– Lack of sun exposure
– Some meds interfere w/
metabolism
•  Fiber
– Regularity problems
– Risk of GI conditions
Potentially problematic nutrients for
mature adults:
•  Vitamin B12 absorption:
– decreased mental function
– personality change
– loss of physical
coordination
– May be diagnosed with a
dementia condition instead
of low B12
• Low dietary intake
– Vit E
– Folate
– Calcium
– Magnesium
– Zinc
– Iron
Optimizing nutritional adequacy
of the gluten-free diet
http://fnic.nal.usda.gov
You might be Niacin deficient IF…
•
•
•
•
In elderly – common deficiency
Bad breath
Canker sores
Confusion, memory
impairment
• Dermatitis, skin eruptions
• Diarrhea
• Emotional instability, irritability,
depression
• Loss of appetite
• Muscle weakness
• Nausea
• Inflammation
• Fatigue
About Niacin (Vit B-3)
•
•
•
•
•
RDA
8 mg - Kids 4-8
12 mg - Kids 9-13
14 mg – Women 14+
16 mg – Men 14+
Reduces cholesterol
Important in DNA repair
Role in producing steroid hormones
Positive role in reversing atherosclerosis
Possible role in reducing Alzheimer’s Disease
Finding Niacin (Vit B-3)
• Animal products
– Liver, heart, kidney
– Chicken, beef
– Fish, tuna, salmon
– Milk
– Eggs
• Nuts and Legumes
• Whole Grains
RDA
8 mg - Kids 4-8
12 mg - Kids 9-13
14 mg – Women 14+
16 mg – Men 14+
• Fruits and vegetables
– Asparagus , Avocados
– Broccoli, Carrots
– Dates, Leafy vegetables,
– Mushrooms, Tomatoes
– Sweet potatoes
You might be Folate deficient IF…
•
•
•
•
•
Anemia
Apathy
Diarrhea
Fatigue, insomnia
Headaches
• Loss of appetite
• Neural tube defects in
fetus
• Paranoia
• Shortness of breath
• Weakness
About Folate (Vit B-9)
•
•
•
•
RDA:
200 mcg - Kids 4-8
300 mcg - Kids 9-13
400 mcg - Women 14+
400 mcg - Men 14+
Important in preventing birth defects
Allergic asthma
Bone health
Helps make new cells, including red blood cells to
prevent folate-related anemia
• Important in DNA function (may impact cancer risk)
Finding Folate (Vit B-9)
• Leafy vegetables (spinach,
asparagus, turnip greens,
romaine)
• Other vegetables (beets,
broccoli, corn, tomato or
vegetable juices, Brussels
sprouts, bok choy)
• Dried or fresh beans and peas
RDA:
200 mcg - Kids 4-8
300 mcg - Kids 9-13
400 mcg - Women 14+
400 mcg - Men 14+
• Fortified grain products
(cereals, flour blends),
sunflower seeds
• Fruits (orange, P/A and
grapefruit juices, cantaloupe,
honeydew melon, banana,
raspberry, grapefruit,
strawberry)
• Liver
You might be B12 deficient IF…
• Anemia
• Constipation
• Depression, irritability,
mental disturbances,
moodiness
• Dizziness
• Fatigue
• Intestinal disturbances,
low stomach acid
• Headaches
• Loss of vibration
sensation
• Mouth lesions
• Numbness
• Spinal cord degeneration
About Cobalamin (Vit B-12)
•
•
•
•
•
RDA:
1.0 mcg - Kids 4-8
1.8 mcg - Kids 9-13
2.4 mcg - Women 14+
2.4 mcg - Men 14+
Role in blood formation
B-12 helps to regulate the active folic acid
B-12 deficiency can lead to pernicious anemia
Key role in normal function of brain and nervous system
Role in normal cell activity, DNA, fatty acid synthesis and
energy production
• Deficiencies can increase fatigue, depression, poor memory,
mania, psychosis
RDA:
1.0 mcg - Kids 4-8
1.8 mcg - Kids 9-13
2.4 mcg - Women 14+
2.4 mcg - Men 14+
Finding (Vit B-12)
In foods that come from animals
• Fish, Shellfish
• Meat (especially liver)
• Poultry, Eggs
• Milk, Milk products
You might be Calcium deficient IF…
• Brittle nails
• Cramps
• Delusions,
depression, insomnia,
irritability
• Osteoporosis
•
•
•
•
Palpitations
Peridontal disease
Rickets
Tooth decay
About Calcium
•
•
•
•
•
•
RDA:
1000 mg - Kids 4-8
1300 mg - Kids 9-14
1000 mg - Women 14-50
1200 mg - Women 50+
1000 mg - Men 14-50
1200 mg – Men 50+
Vitamin D is needed to absorb calcium
Electrical conduction system in the heart
Deficiency can lead to poor blood clotting
Major role in bone health - strength and density
Role in muscle contraction and neurotransmitter release
Excess can lead to impaired kidney function and decreased
absorption of other minerals
Finding Calcium
• Dairy foods (milk , yogurt, and
cheese)
• Seaweeds (kelp, wakame, and
hijiki)
• Nuts and seeds (almonds and
sesame)
• Blackstrap molasses; Beans
• Fruits (oranges, figs)
RDA:
1000 mg - Kids 4-8
1300 mg - Kids 9-14
1000 mg - Women 14-50
1200 mg - Women 50+
1000 mg - Men 14-50
1200 mg – Men 50+
• Whole GF grains (quinoa,
amaranth)
• Vegetables (collard greens,
kale, okra, rutabaga, broccoli,
dandelion greens)
• Fortified products (OJ and soy
milk)
You might be Vit. D deficient IF…
• Elderly woman
• Burning sensation in
mouth
• Diarrhea
• Insomnia
• Myopia
• Nervousness
• Osteomalacia,
osteoporosis, rickets
• Scalp sweating
About Vitamin D
•
•
•
•
•
RDA*:
400 IU - All 8-70
600 IU - All 71+
*It is anticipated that the
FDA will raise these
values in the near future.
Important in bone health
Essential for promoting calcium absorption
Maintaining proper calcium/phosphorus levels
Role in neuromuscular and immune functions
Role in reducing inflammation, cancer risk and other
conditions
Finding Vitamin D
• Very few foods naturally contain
• vitamin D
RDA*:
400 IU - All 8-70
600 IU - All 71+
*It is anticipated that the
FDA will raise these
values in the near future.
– flesh of fish (such as salmon, tuna, and mackerel); fish liver oils
– beef liver, cheese, and egg yolks
– Some mushrooms
• Fortified Foods
– Milk, yogurt , margarine, ready-to-eat breakfast cereals, cereal flours
– Some OJ, Calcium-fortified fruit juices and drinks
• Sunshine: Season, location, time of day, cloud cover, smog, skin
melanin content, and sunscreen impact absorption
About Phosphorus
RDA:
500 mg - Kids 4-8
1250 mg - Kids 9-18
700 mg - Adults 19-70+
• Important in energy production and storage
• Important in transmission of genetic information
• Major structural component of bone and cell
membranes
• Activation of enzymes, hormones and cell-signaling
• Helps maintain normal acid-base balance (pH)
• Binds to hemoglobin in red blood cells and affects
oxygen delivery to the tissues of the body
Finding Phosphorus
RDA:
500 mg - Kids 4-8
1250 mg - Kids 9-18
700 mg - Adults 19-70+
• Meats: organ meats (liver, brains, heart, kidney,
sweetbreads) rabbit, poultry, beef, eggs/yolk, lamb, seafood
• Nuts and seeds
• Vegetables: chickpeas, garlic, lentils, popcorn, soybeans
• Dairy: cheeses
• Grains: wild rice, buckwheat, millet, oats, oatmeal, brown
rice, rice bran
• Other sources: chocolate, kelp, yeast, bone meal.
You might be Iron deficient IF…
• Anemia
• Brittle nails
• Confusion,
depression
• Constipation
• Dizziness
•
•
•
•
Fatigue
Headaches
Inflamed tongue
Mouth lesions
About Iron
•
•
•
•
•
•
RDA:
10 mg – Kids 4-8
8 mg – Kids 9-13
15 mg – Female 14-18
18 mg Female 19-50
8 mg – Female 50+
11 mg – Male 14-18
8 mg – Male 19 – 70+
Carries oxygen in the blood
Prevents iron-def. anemia
Not many GF products are
fortified
Some GF grains are good sources of iron
Take with Vit. C to improve uptake of non-heme
(vegetable) sources of iron
• Do not take with calcium-rich foods
Finding Iron
• Heme iron
– red meats, fish, and poultry
• Non-heme iron
–
–
–
–
–
–
lentils and beans
Molasses
Tofu
Dark green vegetables
Enriched or Fortified cereal/grain products
Tef
RDA:
10 mg – Kids 4-8
8 mg – Kids 9-13
15 mg – Female 14-18
18 mg Female 19-50
8 mg – Female 50+
11 mg – Male 14-18
8 mg – Male 19 – 70+
You might be Zinc deficient IF…
Zinc is the #1 nutritional deficiency in U.S. children (30-70%)
•
•
•
•
•
•
•
Acne, eczema
Amnesia
Apathy, depression, irritability,
memory impairment, paranoia
Brittle nails, white spots on nails
Delayed sexual maturity, growth
impairment
Diarrhea
Fatigue, lethargy
•
•
•
•
•
Hair loss
High cholesterol levels
Immune impairment
Impotence, male infertility
Loss of appetite, loss of sense
of taste, low stomach acid
• Night blindness
• Wound healing impairment
About Zinc
•
•
•
•
•
•
•
•
RDA:
5 mg – Kids 4-8
8 mg – Kids 9-13
9 mg – Female 14-18
8 mg – Female 19-70+
11 mg – Male 14–70+
Taste acuity
Bone mineralization
Essential for cell division, synthesis of DNA
Blood clotting, cognitive functions, fetal growth
Role in activity of enzymes assoc. with protein, carbs, fat, and alcohol
metabolism
Critical to tissue growth, wound healing, connective tissue growth and
maintenance
Immune system function, proper thyroid function, sperm production
Prostaglandin production for smooth muscle contractions, Blood Pressure,
inflammation and body temp.
Finding Zinc
• Oysters, crab,
seafood
• Beef, liver , poultry
• Nuts and seeds,
peanuts and peanut
butter
RDA:
5 mg – Kids 4-8
8 mg – Kids 9-13
9 mg – Female 14-18
8 mg – Female 19-70+
11 mg – Male 14–70+
• Legumes
• Whole grains
• Tofu, Milk
About Magnesium
•
•
•
•
•
•
RDA:
240 mg - Kids 8-13
360 mg – Female 14-18
310 mg Female 19-30
320 mg Female 30-50+
410 mg – Male 14-18
400 mg – Male 19-30
420 mg Male 30-50+
Muscle control, and relaxation
Assisting DNA and other enzymes
that act as genetic building blocks
Distribution and creation of human energy
The production of protein
Magnesium is essential for calcium to work properly
in the body
Finding Magnesium
•
•
•
•
•
•
•
•
RDA:
240 mg - Kids 8-13
360 mg – Female 14-18
310 mg Female 19-30
320 mg Female 30-50+
410 mg – Male 14-18
400 mg – Male 19-30
420 mg Male 30-50+
Dark green, leafy vegetables such
as spinach and even broccoli
Fruits or vegetables (such as
bananas, dried apricots, and avocados)
Nuts (such as almonds and cashews)
Peas and beans (legumes), seeds
Soy products (such as soy flour and tofu)
Whole grains (such as brown rice and millet)
About Fiber
•
•
•
•
•
•
RDA:
25 g – Kids 4-8
26 g – Female 9-18
25 g – Female 19-50
21 g – Female 50+
31 g – Male 9-13
38 g – Male 14-50
30 g – Male 50+
Proper bowel function
Important for a healthy immune system
May reduce risk of cancers
May help with blood sugar control in diabetes
Reduce the risk of coronary heart disease (BP, Chol, Lipids)
May help with weight control (Increased satiety, Decreased
intake )
• Grains with folate helpful in fetal development during
pregnancy
Finding Fiber
•
•
•
•
•
RDA:
25 g – Kids 4-8
26 g – Female 9-18
25 g – Female 19-50
21 g – Female 50+
31 g – Male 9-13
38 g – Male 14-50
30 g – Male 50+
Raw Fruits
Raw Vegetables
Whole GF Grains
Nuts and Seeds
Fiber supplements and fiber-added
foods/beverages
GF Grains – High in Fiber & Nutrients
• Tef: calcium, magnesium, iron, zinc, and B vitamins
• Quinoa: potassium, zinc, phosphorous, iron, B-vits,
magnesium, and calcium
• Amaranth: calcium and iron
• Buckwheat: magnesium, phosphorous, potassium, B6 vits,
iron, niacin, thiamin and zinc
• Indian rice grass (Montina): phosphorous, iron, and Bvitamins
• Chia, flax: omega 3 fatty acids
• Sorghum (milo): phosphorous, potassium, B vitamins, iron
Weight Management
• GF is not calorie-free
– most times GF is more caloric dense than wheat-based options
• Read labels for total calories and serving size
• Choose nutrient-dense foods
– Watch fat, sugar and fiber in foods
• Choose GF specialty foods carefully
• Use more fresh fruits and vegetables and less highly refined,
processed foods
• Exercise
Easy, low cost healthy
gluten-free meals
Tips for easy, healthy meals
•
•
•
•
Eat colors - Eat fresh - Eat naturally GF
Consume whole or enriched gluten-free grains and products
Eat minimally processed foods
Choose products to make cooking easy
– frozen, canned, fresh
•
Cook in volume and freeze
– Cooking parties, fresh and ready meals
•
•
•
Use GF specialty foods in moderation
Exercise – WATER – Rest – Reduce stress
Add nutritional supplement if necessary
Meals with a punch
•
•
•
•
•
•
•
•
Yogurt with fresh fruit and granola
Whole grain pancakes or waffle breakfast sandwich
GF oatmeal, grits with dried fruit
Semi-homemade soups with beans and grains
Cornbread or corn cakes vs. GF breads
Lean meat stews
Steamed vegetables and salads with protein
Sweet potatoes/yams vs white potatoes
Gluten Free Super Foods
Kefir
People with Gluten Intolerance and/or Celiac Disease commonly
experience issues with their digestive tract. The pro-biotic cultures in
kefir can be beneficial to your digestive health. Kefir possesses a
high content of antioxidants and B-vitamins which can help heal the
tissues in the gut. Dairy-free alternatives are available, such as
coconut milk kefir and soy milk kefir. It makes a wonderful base for a
smoothie. As it contains yeasts, kefir can be used to make a
sourdough bread. It is also useful as a buttermilk substitute in baking.
Gluten Free Super Foods
Flaxseed
This popular seed is high in omega-3 fatty acids. Studies
have shown it has anti-inflammatory properties and has a mild
estrogenic effect that may benefit people with chronic
inflammation, skin and cardiovascular issues. It is rich in
lignans that help soothe the intestinal tracts. The fiber found in
flax seeds can help repair damage to the small intestine.
Gluten Free Super Foods
Coconut
Coconuts provide essential medium chain fatty acids that
protect and heal the body. Its meat is a densely packed
source of fats and oils that have been scientifically studied for
their anti-inflammatory and anti-pathogenic properties.
Moreover, coconut meal can be ground into a flour that is
excellent for gluten-free baking and cooking. The saturated
oils are plant based and do not have the same un-healthy
effects that animal based saturated fats do.
Gluten-Free Nutrition Guide
For more information about nutritional needs of persons
with gluten intolerances visit: www.gluten.net
This information provided by Cynthia Kupper, RD, Executive
Director of GIG with the support of Bastyr University Nutrition
and Dietetic Interns